Monday, August 12, 2013

Why is the CDC Taking Research Funding from a Pharmaceutical Company?

When I worked at the Centers for Disease Prevention and Control (CDC) from 1993-1995, I always considered it to be an independent, objective source of public health scientific research and policy analysis. I can attest that all of the research I conducted there was independent and free of any influence from corporate interests. None of the research I conducted was funded by, or conducted in partnership with any tobacco or pharmaceutical companies, nor did we farm out any research to be funded by or associated with corporations.

It's remarkable how much things have changed since I left the agency in 1995.

Last week, the CDC published an article in its journal "Preventing Chronic Disease" that assessed the economic impact of smoke-free bar and restaurant laws. The research found that there was no adverse economic impact of these laws in the nine states studied.

This may sound innocent enough.

Consider, however, that the research was funded through the CDC Foundation, which contracted with RTI International to conduct the study. And who actually funded the study?

And Pfizer wasted no time in boasting about its partnership with CDC. In the very press release that was supposedly intended to announce the important scientific results of the study, the CDC Foundation was sure to include this public relations statement from the corporation:

"Pfizer is proud to have partnered with the CDC Foundation and CDC on
this important research initiative and we are very encouraged by the
results,” said Freda C. Lewis-Hall, MD, FAPA, executive vice president
and chief medical officer, Pfizer."

So now you know the truth. The real story behind this research is that its true purpose - from the perspective of Pfizer - was to create the public perception that Pfizer and CDC are partners.

That's all very charming, but there's just one problem. It is not appropriate for a government public health agency to partner with the very corporations about whose drugs or products that agency issues recommendations about their approval, disapproval, or use.

Suppose I were a corporation that manufactured a vaccine about which CDC was going to make a recommendation for either approval or disapproval. Wouldn't I just love the opportunity to partner with the CDC so that I could influence their decision with money, and to do it legally no less?

Well, this is exactly what the CDC is now allowing corporations to do by accepting their donations in return for the opportunity to partner with, and thus influence, the agency's decisions. And the CDC Foundation acknowledges this right on its web site, writing that two of the "added values" to corporations of partnering with the agency are:

simplifying "the process of partnering with a complex federal agency."

The collaboration with CDC scientists is mutually beneficial because the scientists get funding with which to conduct additional research and the corporation gets a perfectly legal opportunity to exert an influence on federal public health policy at the highest level.

For example, the CDC makes recommendations regarding the use of vaccines. One vaccine about which the CDC deliberated was Pfizer's Prevnar. The CDC Advisory Committee on Immunization Practices (ACIP) regularly makes recommendations regarding the use of vaccines.

Furthermore,
CDC makes recommendations regarding a wide range of other drugs,
related to the prevention and treatment of all sorts of infectious and
chronic diseases.

Through its partnership
with CDC and the CDC Foundation, Pfizer has the potential to gain an
increased corporate image among CDC staff, and therefore, to influence
decisions that the CDC makes about the approval or disapproval of Pfizer
products. I am not arguing that the influence is a conscious one. I’m
not saying that CDC will consciously say to itself: we received money
from Pfizer so let’s be extra nice to them in our formulation of public
recommendations. However, I do believe that the receipt of this funding
from Pfizer, which the CDC Foundation praises heavily in its press
release, will have the effect of improving the company’s image within
the agency, and that it could potentially have a subconscious effect on
the agency and therefore influence its actions. This is precisely how
conflicts of interest work.

If this were an
individual researcher rather than an agency, there is no question that
the partnership with Pfizer and other pharmaceutical companies would
represent a conflict of interest. I see no reason why it is not a
conflict just because the CDC is an agency rather than an individual.
The conflict of interest would be expected to work in exactly the same
way.

The CDC Foundation has a large number of partnerships
with Big Pharma companies, including GlaxoSmithKline, Bristol-Myers
Squibb, Eli Lilly, Johnson & Johnson, Novartis, and Sanofi-Aventis.
So the problem is not restricted to this one partnership with Pfizer.

The CDC Foundation also partners with the Coca-Cola Company. According to the CDC Foundation, partnerships are only accepted with "Corporations whose goals or philanthropic interests align with CDC’s work...".

In
what way do Coca-Cola’s goals align with those of CDC? The CDC is in
the business of trying to improve the public’s health. Coca-Cola is in
the business of trying to market and sell sugar-laden soft drinks that
contribute to the obesity epidemic. The CDC presumably favors school
nutrition improvement. Coca-Cola has opposed virtually every piece of
state legislation to improve school nutrition. The CDC presumably wants
to decrease the consumption of sugar-laden soft drinks. Coca-Cola is
working to sustain the sales of its sugar-laden soft drinks.

Don’t
get me wrong. I’m not criticizing Coca-Cola. They are not in business
to reduce obesity. They are in business to sell soft drinks and I
wouldn’t argue that they should do otherwise. If anything, I commend
Coca-Cola for being brilliant enough to use its money in a way that may
soften the CDC’s stance on sugar-laden soft drinks.

The CDC Foundation also partners with Abbott Laboratories.

How
could the CDC’s partnership with Abbott Laboratories not constitute a
violation of its corporate partnership policy? Abbott Laboratories is
one of the leading manufacturers of infant formula, which it is pushing
to pregnant women through programs such as the giveaway of infant
formula in hospitals. Presumably, the CDC has a vested interest in
promoting increased breastfeeding and reduced use of infant formula.
This certainly appears to represent a conflict of interest.

The CDC Foundation also partners with Georgia Pacific.

How could CDC’s partnership with Georgia Pacific not constitute a conflict of interest? Georgia Pacific is one of the nation's leading corporate polluters. In what way does that align with CDC's mission and goals?

The
rest of the story is that through its corporate partnerships with
companies which either produce products that are causing harm to the
public or which are within the scope of CDC’s public recommendations,
the CDC Foundation is creating significant conflict of interests that
conflict with its stated policy of avoiding such conflicts. I believe
that these partnerships taint the scientific objectivity of the agency,
are inconsistent with the stated mission and policy of the CDC and CDC
Foundation, and represent a disservice to the public’s interest.

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About Me

Dr. Siegel is a Professor in the Department of Community Health Sciences, Boston University School of Public Health. He has 32 years of experience in the field of tobacco control. He previously spent two years working at the Office on Smoking and Health at CDC, where he conducted research on secondhand smoke and cigarette advertising. He has published nearly 70 papers related to tobacco. He testified in the landmark Engle lawsuit against the tobacco companies, which resulted in an unprecedented $145 billion verdict against the industry. He teaches social and behavioral sciences, mass communication and public health, and public health advocacy in the Masters of Public Health program.